PROFESSIONAL SUMMARY:

• Over 7 years of diverse business analysis experience in Health Care industry, wif strong knowledge in claim and billing domains and efficient IT skills.
• Thorough knowledge of industry standard SDLC practices and UML tools.
• Expertise in Quality Assurance to fulfill requirements for product and service.
• Extensive knowledge and experience in Change Management. Helped organizations go through mission changes, strategic changes, operational changes and technological changes.
• Expertise in translating User Requirements into Business Requirements and Use Cases.
• Highly proficient in documenting, writing and implementing Functional and Non - Functional Requirements, Risk Analysis.
• Experienced wif SDLC models such as Waterfall, Agile/Scrum.
• Advanced analytical and problem-solving skills in designing, developing and implementing innovative business processes using new approaches and technologies.
• Experienced in collecting and transmitting the Business Requirements for the project and translating them into functional specifications and detailed documentation.
• Experienced facilitator for different types of requirement gathering sessions such as Joint Application Development (JAD), one-on-one & group interviews, requirement workshops and Joint Requirement Planning (JRP).
• Greatly knowledgeable of medical and health care standards and regulatory vehicles such as HIPAA, CMS, ICD, MMIS, NPI, ICS, EDI, etc.
• Well experienced in EDI and HIPAA wif multiple transactions involving claims handling and processing, wif payer and provider experience (276 & 277, 278, 837, 834, 835), HL7.
• Experienced in analyzing methods such as Verification & Validation, GAP analysis, SWOT analysis, Risk analysis, Business Project analysis, Process Flow analysis and Failure analysis.
• Experience in system conversions (Mapping, Migrating, Enhancement) such as HIPAA X12 4010 codes to X12 5010 codes and ICD-9-CM codes to ICD-10-CM & PCS codes in Medicaid, Medicare, Procedural and Diagnostic codes and Claims processes.
• Excellent written and verbal communication skills. Demonstrated team leading and integrative learning skills in many professional and volunteering projects.
• Well versed wif CPT, HCPCS codes, National Drug Code (NDC) Coding Systems, HL7 standards, US Health Care System and Medical Terminology experience.
• Expert in User Acceptance Testing (UAT) and Performance testing using SOAP UI.
• Thorough knowledge of HP Quality Center 9.2/10.0.
• Created and maintained Requirements Traceability Matrix (RTM).
• Ability to work calmly and successfully under tremendous pressure and multiple project deadlines.

TECHNICAL SKILLS:

Business Methodologies: Waterfall, Agile/ Scrum, RUP

Languages: SQL, SQL CRUD, HTML, UML, Java

Tools: HP Quality Center, Rational Clear Quest, SOAP UI, Rational Requisite Pro, MS Office Suite, SQL Developer, TOAD

Modeling & Manipulation tools: UML (Use Cases, Class, Sequence, and Deployment Diagrams), Microsoft Visio, MS Project

Operating Systems: MAC OS, DOSWindows 98/XP/Vista/7

BRDs, Functional & Non: Functional Documents, Use Cases, GAP analysis, AS-IS-Flow Documents, Risk Analysis, Business Process Flow Analysis & Design

Methodologies: Agile, Scrum, RUP, Spiral, Waterfall, RAD, CMM, Six Sigma, RM-ODP

Arena/Domain: Healthcare, HIPAA 4010/5010, ICD 9/10, Biomedical QA & FDA classifications

Testing: Validation and Verification processes, Bench testing, In Vivo and In Vitro testing, Claim Processing UAT

PROFESSIONAL EXPERIENCE:

Confidential

Business Analyst

Responsibilities:

• Performed Discovery studying towards the CMHC to learn about users’ needs and desires based on the interaction wif existing programs B23 (Birth to Three) and EMR.
• Collaborate wif business units to understand Strategic Goals. Identify defects and improve departmental performance by supporting quality, operational efficiency and defined business requirements.
• Recommend and guarantee new product and/or process enhancements to meet defined business requirements. Under the light supervision of the VP and Director, maneuvers multiple tasks wif a proactive vs. reactive approach to changing priorities.
• Demonstrated a high level of working knowledge wif IS methodologies and processes (i.e. Project Life Cycle, System Development Life Cycle and IS Change Management process).
• Facilitates business/functional requirement review, approval, and sign-off sessions.
• Participated in Form Design sessions to gain a more thorough knowledge of the existing EMR system followed by using the staging application to enhance the requirements documentations.
• Develops necessary programming and configuration to TEMPeffect interface changes. This includes analysis, design, coding, testing, implementing, and documentation as needed to complete the request. This will also include changes for projects being worked on by other staff members.
• Created business use-cases, flow diagrams and validated business rules and data elements for EOB and adjustments application.
• Created and updated Product Matrix for traceability purpose, and to halp organize all the documents in a more productive way.
• Took part in developing test plan and developed UAT test cases associated wif the functional requirements.
• Prepared requirements for the reporting field specifications.

Confidential, Franklin Lakes, NJ

Business Analyst

Responsibilities:

• Performed Rapid Assessment for over 20 applications such as CBM, DUR, Order processing etc for the MEDICARE - D and commercial business and conducted a SWOT analysis.
• Participated in numerous Healthcare presales initiative for HL7 based EHR applications, ICD9 - ICD10 conversions.
• Researched and comprehended the claims adjudication and reimbursement systems based on ICD-10 standards.
• Helped the organization go through the HIPAA transition smoothly by using different Change Management methodologies.
• Specified in EDI 276/277 and 278 transactions, which EDI 278 transaction was used either as a one-way transaction, or as a two-way “inquiry/response” type of transaction.
• Created business use-cases, flow diagrams and validated business rules and data elements for EOB and adjustments application.
• Took part in developing test plan, test scripts, and developed UAT test cases associated wif the functional requirements.
• Created Business Information Rules Matrix for Claims regression automation capturing various products and capabilities for the MEDICARE-D business.
• Designed End-to-End scenarios and process flows for testing Medicare-D business.
• Created Healthcare and Medicare-D material for onshore and offshore teams.
• Prepared requirements for the reports specifications.
• Presented approach for Model driven testing to the client.
• Participated in developing test plan, test scripts, and developed UAT test cases associated wif the functional requirements.
• Created business use-cases, flow diagrams and validated business rules and data elements for EOB and Adjustments application.

Confidential, Wellesley, MA

Senior Business Analyst

Responsibilities:

• Established business process flows and work flows. Worked closely wif the lead architects and analysts to develop assessments and project plans.
• Updated project progress and status through MS Project.
• Assisted users in prioritization process and the development of strategies and performance goals.
• Partnered wif Quality Assurance on development of test cases, and cross-walked functional specifications wif test scenarios, and signed-off on risks, and final status of implementation.
• Translated business requirements into functional requirements for developers.
• Involved in up-grading HIPAA X12 4010 transactions to HIPAA X12 5010.
• Worked wif the users and different levels of management to identify requirements, use cases and to develop functional specifications.
• Analyzed and documented the changes in the compliance rules for adverse action redesign.
• Led sub-team meetings and participate on core team discussions for major project initiatives.
• Created use cases after accessing scope of the project and understanding the business processes.
• Developed UAT test cases and performed supporting role to the testing team.
• Provided management wif financial advice and counseled on all pertinent business matters by supplying ongoing, timely, and meaningful financial analysis, both routine and as needed, of business results, projections, innovation projects and other ad hoc projects.
• Managed all the requirements along wif making requirements available to all team members.
• Performed Root Cause Analysis, uncover critical business requirements, and facilitate solution delivery.
• Conducted asset management, risk analysis of the requirements and traceability focus areas of the various projects and worked wif the project team to halp them identify the high-risk areas.
• Coordinated wif other process teams to identify cross-program dependencies and leverage resources appropriately.

Confidential, Southfield, MI

Business Analyst

Responsibilities:

• Conducted JAD sessions, user interviews, gathered requirements, and analyzed the requirements.
• Created Activity Diagrams, Sequence Diagrams, and Class diagrams.
• Analyzed data and created Use Case Diagrams, and ER diagrams using MS Visio.
• Managed and maintained Requirements Traceability Matrix.
• Maintained and kept track of stakeholder’s requests for enhancements and changes using Rational Clear Quest.
• Organized and maintained SharePoint space for sharing deliverables and important project information wif different teams.
• Designed and implemented basic MySQL queries for QA testing and report / data validation.
• Understood the Business Logic, User Requirements and test-objectives to develop Test plans, Use Case Scenarios.
• Performed User Acceptance Testing (UAT).

Confidential, IL

Business Analyst

Responsibilities:

• Created Use-Cases and Requirements documents to document business needs.
• Requirements were gathered through interviews wif loan analysts, credit analysts and other potential users of the application.
• Worked on market risk analysis and risk management like continuous time finance & asset pricing and documentation.
• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.
• TEMPEffectively managed knowledge transfer and co-ordination wif the off shore development.
• Created Business Requirements Documents (BRDs) and Functional Requirement Documents (FRD).
• Designed and developed scenarios based on Business Requirements.
• Followed the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the implementation of Rational Unified Process effort in different iterations and phases (Inception, Elaboration, Construction and Transition) of the Software Development Life Cycle (SDLC).
• Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
• Conducted Use-Case reviews and identified gaps, leading to the improvement of the application.
• Created a cost analysis document that outlines the TEMPeffect of proposed changes on the project schedule and costs.
• Worked wif Software Engineers to ensure clear communications on requirements and defect reports.
• Validated the test scripts by performing User Acceptance Testing (UAT).
• Involved in designing a data model and created reports to calculate the profit and loss margin by year, quarter and month.
• Ensured accuracy of the data collected and stored in the corporate support system.
• Performed data review, evaluate, design, implement and maintain company database.
• Involved in construction of data flow diagrams and documentation of the processes.
• Interacted wif end users for requirements study and analysis by Joint Application Development (JAD).
• Performed Gap Analysis between the present data warehouse to the future data warehouse being developed and identified data gaps and data quality issues and suggested potential solutions.
• Participated in system and use case modeling like activity and use case diagrams.
• Analyzed user requirements and worked wif the data modelers to identify entities and relationship for data modeling.
• Actively participated in the design of data model like conceptual, logical models using Erwin.
• Coordinated changes wif developers, technical writers and End users.

Confidential

Business Analyst

Responsibilities:

• Managed Macro Funds, Derivatives such as Options / Swaps, Private Equity, Long Dated Value funds and Partners Funds are collected, consolidated and reconciled.
• Documented lapses in plans, initiated timely corrective actions, and renegotiated contract wif the vendor.
• Arranged meetings wif cross-functional team including Business Project Managers, Technical Project Manager, Business Analysts, Finance Manager, Sales, Key Developers, Key Marketing Members, QA, and Offshore Development Team.
• Performed a custom Excel application used by financial planners and their assistants. Supervised and trained data entry clerks and end users in use of this tool and several other Windows applications.
• Created use-cases based on Business Requirements, using Power Designer for workflow diagrams and to sketch business processes.
• Built a chain between the business team and technical team and instrumental in resolving conflicts between them and Involvement in Project Management including documenting and scheduling in the system life cycle.
• Re-engineered the firm’s proprietary financial planning.
• Communicated wif Application users and Developers to understand application Flow, Functionality and Business rules and requirements.
• Gathered the client’s requirements for developing an updated ITIL based Configuration Management System including process, procedures and integration wif discovery and real time service status modelling tools.

Confidential

Business Analyst

Responsibilities:

• Conducted interviews to understand the workflow of business in a highly regulated environment.
• Researched and analyzed the project to become more familiar wif the current process and functionality of the program. Reviewed legacy documentation and interacted wif various staff that uses the system.
• Facilitated meetings to bring on board the key stakeholders, and ensured they were informed about the status of the project.
• Gathered requirements working wif SMEs in cooperation wif IT Web Development team.
• Identified gaps and conducted GAP analysis.
• Created UML diagrams created and conducted Use-Case reviews.
• Worked wif testing user groups to answer questions on BRD.